Control of Dental Caries in Children and Adolescents Using Fluoride: An Overview of Community-Level Fluoridation Methods.

The maintenance of oral health is a crucial aspect of general well-being; however, a significant proportion of the worldwide population experiences a range of oral diseases. Dental caries is a highly prevalent non-communicable disease globally, especially in children and adolescents. Fluoride is involved in the control of dental caries, primarily by decreasing the critical pH for dental hard tissue dissolution and decreasing enamel solubility. Due to the substantial data supporting the efficacy of fluoride in controlling dental caries, many community-level fluoridation initiatives have been devised and executed as global public health preventive interventions. These initiatives encompass the fluoridation of water, salt, and milk. Water fluoridation is considered safe and effective when fluoride levels are maintained within the recommended range (0.6 to 1.1 mg/L). Salt fluoridation has a cariostatic potential similar to that of water fluoridation, and a fluoride concentration of 250 micrograms per gram in salt is not associated with an increased risk of developing dental fluorosis. However, there is currently an effort to reduce the consumption of table salt in order to mitigate the harmful effects of excessive salt consumption. It has been hypothesized that fluoride food supplementation, such as fluoridated milk, is associated with a decrease in caries experience in permanent teeth; however, the effect is not clear in primary teeth. Public-level fluoride interventions are more cost-effective than the operative care of caries lesions and limit the burden of care. The administration of fluorides should be conducted using safe methods, limiting ingestion, and adhering to the guidelines set by international and national health agencies in each country. This is particularly important when considering children with developing dentitions. Fluoride is an important tool in the control of dental caries, but it is crucial to combine it with good oral hygiene, a healthy diet, and regular visits to a dental professional to maintain long-term oral health.

Socioeconomic Inequalities in Alcohol and Tobacco Consumption: A National Ecological Study in Mexican Adolescents.

Alcohol and cigarettes are the psychoactive substances that adolescents use most frequently. When both addictions are combined, they carry the worst burden of disease globally. The objective of this study was to identify whether socioeconomic factors correlate with alcohol and tobacco consumption in Mexican adolescents aged 10 years or more and to establish the relationship in the consumption between the two substances. This ecological study utilized data describing alcohol and tobacco consumption among adolescents aged 10-16 years (n = 48,837 ≈ N = 11,621,100). Having ever consumed any alcohol-containing beverage constituted alcohol consumption. Smoking a cigarette within 30 days constituted cigarette consumption. For both variables, the state-level percentages reported in the survey were used. Diverse socioeconomic variables were collected from official sources. Data on the prevalence of tobacco use and alcohol consumption were entered into an Excel database estimated for each of the states of the Mexican Republic, as well as the socioeconomic variables. We performed the analysis using Stata 14. Consumption prevalence was 15.0% for alcohol and 4.2% for tobacco. Alcohol consumption was not correlated with any studied socioeconomic variable (p > 0.05). The prevalence of tobacco consumption among elementary school students correlated (p < 0.05) with the portion of the population living in private dwellings without sewage, drainage, or sanitation (r = 0.3853). The prevalence of tobacco consumption among middle-school adolescents correlated with the portion of the employed population that earned up to two minimum wages (r = 0.3960), the percentage in poverty by income 2008 (r = 0.4754) and 2010 (r = 0.4531), and the percentage in extreme poverty by income 2008 (r = 0.4612) and 2010 (r = 0.4291). Positive correlations were found between tobacco consumption and alcohol consumption among both elementary (r = 0.5762, p=0.0006) and middle-school children (r = 0.7016, p=0.0000). These results suggest that certain socioeconomic factors correlate with tobacco consumption but not alcohol consumption. A correlation between alcohol consumption and tobacco consumption was observed. The results can be used for developing interventions in adolescents.

Tooth Loss and Associated Factors in Mexican Older Adults in Nursing Homes: A Multicenter Cross-Sectional Study.

The objective of this study was to determine the experience of tooth loss and associated factors in older adults and elderly residing in nursing homes. A cross-sectional study was conducted in Mexican older adults and elderly aged ≥60 years living in four nursing homes (two in Mexico City, Mexico: one in Cuernavaca, Morelos, and one in Oaxaca, Oaxaca). The data were collected at the facility (home nursing) by two dentists in 2019. To determine the number of tooth loss and DMFT, a clinical oral examination was performed. In addition, a questionnaire was applied to determine diverse independent variables (demographic, socioeconomic, and behavioral). The analysis was performed using nonparametric tests and negative binomial regression (p < 0.05). 257 subjects were included. The mean age was 81.25 ± 9.02 years, and 60.7% were women. The mean number of lost teeth was 18.78 ± 9.05 (women = 19.43 ± 8.59 and men = 17.77 ± 9.68; p > 0.05). In the multivariate negative binomial regression model, it was found that, for each one-year increase in age, the mean tooth loss increased 0.92% (p < 0.05). In current smokers (p < 0.01) and in those who brush their teeth < 2 times a day (p < 0.01), the average of tooth loss increased 22.04% and 61.46%, respectively. The experience of tooth loss in Mexican older adults and elderly was high. Demographic (age) and habit of behavior (tobacco use and less frequent tooth brushing) were associated with increased tooth loss. It is important to promote oral health programs for institutionalized older adults.

Characterizing Socioeconomic Inequalities in Professionally Applied Topical Fluoride Treatment Courses in Schoolchildren from a Developing Country.

The objective of the present study was to characterize socioeconomic inequalities in the patterns of professionally applied topical fluoride (PATF) in Mexican schoolchildren. A cross-sectional study was carried out on 3029 Mexican schoolchildren. A questionnaire was administered to caregivers to determine sociodemographic, socioeconomic, and behavioral variables. The dependent variable was prevalence of PATF, coded as 0 = without PATF and 1 = with PATF, at any point in life, and separately, in the previous year. Various indicators of socioeconomic position were included. Logistic regression was used in the final multivariate analysis. The prevalence of PATF any time in life was 33.8%, while in the previous year it was 11.4%. The variables associated (p < 0.05) with PATF any time in life were child's older age (OR = 1.12), older age when tooth brushing started (OR = 1.57), higher brushing frequency (OR = 1.60), having health insurance [public (OR = 1.61) or private (OR = 1.45)], if family owned a car (OR = 1.29) and better socioeconomic position [parents' education, second (OR = 1.48) and third (OR = 1.75) tertile]. For PATF in the previous year, the variables associated were older age of mother (OR = 1.03), older age when tooth brushing started (OR = 1.99), higher brushing frequency (OR = 1.68), having health insurance [public (OR = 1.62)] and better socioeconomic position (parents' education, second (OR = 1.57) and third (OR = 1.97) tertile). This study suggests the existence of socioeconomic inequalities in PATF, manifested through socioeconomic position, access to health insurance and household having a car. Identifying and addressing PATF inequalities would improve oral health in the child population.

Factors Associated with Self-Report of Type 2 Diabetes Mellitus in Adults Seeking Dental Care in a Developing Country.

The aims of the present study were to identify the prevalence and risk indicators of type 2 diabetes mellitus (T2DM) in urban-based Mexican adults seeking care in a university-based triage/intake dental clinic, and to develop a predictive model. A cross-sectional study was conducted on 3354 medical/dental records of adults who sought care at the triage/intake dental clinics of a public university. The dependent variable was self-report of a previous diagnosis of T2DM made by a physician. Several socio-demographic and socioeconomic covariates were included, as well as others related to oral and general health. A multivariate binary logistic regression model was generated. We subsequently calculated well-known statistical measures employed to evaluate discrimination (classification) using an (adjusted) multivariate logistic regression model (goodness-of-fit test). The average age of patients was 42.5 ± 16.1 years old and the majority were female (64.1%). The prevalence of T2DM was 10.7% (95%CI = 9.7−11.8). In the final multivariate model, the variables associated (p < 0.05) with the presence of T2DM were older age (40 to 59 years old, OR = 2.00; 60 to 95 years old, OR = 2.78), having any type of health insurance (OR = 2.33), having high blood pressure (OR = 1.70), being obese (OR = 1.41), and having a functional dentition (OR = 0.68). Although the global fit of the model and the calibration tests were adequate, the sensitivity (0.0%) and positive predictive (0.0%) values were not. The specificity (100%) and negative predictive (89.3%) values, as well as the correctly classified (89.3%) value, were adequate. The area under the ROC curve, close to 0.70, was modest. In conclusion, a prevalence of T2DM of 10.7% in this sample of Mexican adults seeking dental care was similar to national figures. Clinical (blood pressure, BMI and functional dentition), demographic (age), and socioeconomic (health insurance) variables were found to be associated with T2DM. The dental setting could be appropriate for implementing preventive actions focused on identifying and helping to reduce the burden of T2DM in the population.

The Effect of Deproteinizing Agents on Bond Strength of Resin-based Materials to Enamel: A Systematic Review and Meta-Analysis of In Vitro Studies.

PURPOSE: To systematically review the literature to evaluate whether the bond strength of resin-based materials to enamel is affected by deproteinizing agents. MATERIALS AND METHODS: This systematic review and meta-analysis was conducted according to the PRISMA statement. PubMed, ISI Web of Science, Cochrane Library, SciELO, Scopus, LILACS, IBECS, and BVS databases were screened up to December 2020. Eligibility criteria included in vitro studies that reported the effect of a deproteinizing agent applied before or after acid etching on the immediate or long-term bond strength of resin-based materials to enamel. The meta-analysis was carried out using Review Manager (version 5.3.5). A global comparison was performed with the standardized mean difference based on random-effect models at a significance level of α = 0.05. RESULTS: A total of 23 studies were included in the meta-analysis. In all the studies, only the immediate bond strength was evaluated. The bond strength of the materials was improved by the application of NaOCl or papain prior to enamel etching with phosphoric acid (p ≤ 0.006). None of the deproteinizing agents had a significant effect when applied after etching with phosphoric acid (p ≥ 0.27). CONCLUSIONS: Based on in vitro studies, deproteinization with sodium hypochlorite or papain-based agents increases the immediate bond strength of resin-based materials to enamel only when used prior to phosphoric-acid etching.

Association of Edentulism with Various Chronic Diseases in Mexican Elders 60+ Years: Results of a Population-Based Survey.

OBJECTIVE: To determine the association of edentulism with different chronic diseases and mental disorders in Mexicans aged 60 years and over. MATERIAL AND METHODS: A cross-sectional study was carried out using data from the World Health Survey for Mexico, in a probabilistic, multi-stage cluster sampling framework. Data for self-report of chronic diseases (diabetes, arthritis, angina pectoris and asthma), mental disorders (depression and schizophrenia) and edentulism were analyzed. Edentulism data were available for 20 of the 32 States of Mexico. Statistical analysis was performed in Stata 14.0 using the svy module for complex sampling (Complex nature under which individuals are sampled). RESULTS: In total 4213 subjects were included, representing a population of 7,576,057 individuals. Mean age was 70.13 ± 7.82 years (range 60 to 98); 56.2% were women. Chronic diseases' prevalence and mental disorders prevalence were as follows: diabetes 15.0% (N = 1,132,693); arthritis 13.2% (N = 1,001,667); depression 5.5% (N = 414,912); angina pectoris 4.5% (344,315); asthma 3.6% (N = 269,287); and schizophrenia 2.2% (N = 16,988). The prevalence of edentulism was 26.3%, which pertained to 1,993,463 people aged 60 years and over. Angina in women aged 60 to 69 years (p < 0.05) and depression in men aged 70 years and over (p < 0.0001) were associated with higher prevalence of edentulism. CONCLUSIONS: There was generally sparse association between edentulism on chronic diseases and mental disorders included in the study, except for women aged 60 to 69 years for angina, and in men aged 70 and over, for depression. Although our findings are misaligned with previous reports, longitudinal studies are required to test causal and temporal relationships between edentulism with chronic diseases and mental disorders.

Experience and Prevalence of Dental Caries in 6 to 12-Year-Old School Children in an Agricultural Community: A Cross-Sectional Study.

OBJECTIVE: To describe the experience and prevalence of dental caries in schoolchildren aged 6-12 years belonging to agricultural manual worker households. MATERIAL AND METHODS: A comparative cross-sectional study was conducted in two groups of schoolchildren: One considered "children of agricultural worker migrant parents" (n = 157) and the other "children of agricultural worker non-migrant parents" (n = 164). Epidemiological indices for dental caries were calculated for primary (dmft) and permanent (DMFT) dentitions, and compared in terms of age, sex, and the Simplified Oral Hygiene Index (SOHI). Two binary logistic regression models for caries prevalence in primary and permanent dentitions were generated in Stata. RESULTS: For primary dentition, we observed the following dmft index: Non-migrants = 1.73 ± 2.18 vs. migrants = 1.68 ± 2.14. Additionally, we recorded the following caries prevalence: Non-migrants = 59.1% vs. migrants = 51.3%. For permanent dentition, we observed the following DMFT index: Non-migrants = 0.32 ± 0.81 vs. migrants = 0.29 ± 0.95. Further, we recorded the following caries prevalence: Non-migrants = 17.6% vs. migrants = 12.8%. No differences were observed for either dentition (p > 0.05) in caries indices and their components or in caries prevalence. When both caries indices (dmft and DMFT) were combined, the non-migrant group had a higher level of caries experience than the migrant group (p < 0.05). No relationship (p > 0.05) with migrant status was observed in either multivariate models of caries prevalence. However, age did exhibit an association (p < 0.05) with caries. Only the plaque component of SOHI was associated (p < 0.05) with caries in permanent dentition. CONCLUSIONS: Although over half of school children from agricultural manual worker households had caries in either or both dentitions and a considerable proportion were untreated lesions, the prevalence levels were somewhat lower than other reports from Mexico in similar age groups. No statistically significant differences were found in caries experience or prevalence in either dentition between non-migrant and migrant groups.

Preterm birth associated with periodontal and dental indicators: a pilot case-control study in a developing country.

Introduction: Preterm delivery is a multifactorial health problem that represents a serious public health problem around the world. In recent years, there has been an increase in scientific evidence suggesting associations between oral health status (mainly periodontal disease and tooth loss) and an increased risk of systemic diseases and various adverse pregnancy outcomes. This study explores the association between indicators of oral health and preterm delivery in a sample of Mexican pregnant women.Materials and methods: A case-control study was carried out with 111 pregnant (36 cases, 75 controls) who received prenatal care and delivered in an obstetric hospital in Pachuca, Mexico. Clinical files were reviewed to obtain the necessary information for the variables studied. The dependent variable was preterm delivery and the independent variables were gingivitis, periodontitis, DMFT index and its components, the number of decayed teeth with pulpal exposure or endodontic lesions, age of the mother, education, alcohol use, smoking status, number of gestations, and sex of the newborn.Results: The average ages were similar between the cases and the controls (24.29 ± 5.42 versus 24.89 ± 5.67, p = .5781). Significant differences were observed with gingivitis (p < .01) and periodontitis (p < .001). In addition, when the severity of gingivitis or periodontitis increased, the percentage of cases of preterm delivery increased (p < .01). The average number of teeth lost was higher among the cases than among the controls (1.33 ± 1.89 versus 0.81 ± 1.82, p < .05).Conclusions: It was found that gingivitis, periodontitis, and tooth loss were associated with preterm delivery. It is necessary to carry out actions aimed at the preservation of oral health in pregnant patients to avoid adverse results. These findings indicate a likely association, but it needs to be confirmed by large and well-designed studies.

Tooth loss in patients with and without diabetes: A large-scale, cross-sectional study of Mexican adults.

BACKGROUND: The objective of this study was to compare the experience and distribution of tooth loss in people with and without diabetes. METHODS: The authors conducted a comparative cross-sectional study of patients at a public university. Analysis included medical records of those treated from 2013 through 2017. The dependent and main independent variables were the number of missing teeth and a diagnosis of diabetes, respectively. As covariables, the authors analyzed the sociodemographic and socioeconomic characteristics, as well as the general and oral health status of patients. A multivariate model based on negative binomial regression was constructed. RESULTS: Of the 3,406 medical records analyzed, 64.2% (n = 2,185) pertained to women, the mean age was 42.45 years, 87.9% did not have diabetes, and 12.1% had received a diagnosis of diabetes. The mean (standard deviation) number of missing teeth was 7.46 (7.89), 7.09 (7.60) in patients without diabetes, and 10.12 (9.32) in patients with diabetes. According to our final multivariate model, the expected mean number of missing teeth was 11.4% higher in patients with diabetes than in those without (P = .006). For every 1-year increase in age, the expected mean number of missing teeth increased by 3.9% (P < .001). Other variables related to tooth loss included occupation, marital status, and type of insurance. CONCLUSIONS: The results of the study indicate that the mean number of missing teeth is higher in people with diabetes and suggest that certain socioeconomic inequalities exist in the area of oral health. PRACTICAL IMPLICATIONS: The population needs to be apprised of the impact of diabetes on oral health.

Correlation between the caries status of the first permanent molars and the overall DMFT Index: A cross-sectional study.

To analyze whether a correlation exists between the caries status (Decayed, Missing and Filled Teeth, DMFT Index) of the first permanent molars (FPMs) and that of the full permanent dentition of Mexican adolescents, and to propose its use in large epidemiological studies of dental caries.We conducted a cross-sectional study of 1538 adolescents from 12 to 15 years old. Based on a clinical oral examination, we determined the DMFT Indices of their FPMs (FPM-DMFT) and of their full permanent dentition (comprehensive DMFT Index). We explored each FPM to determine whether it was with or without caries, filled, missing or sealed. For our statistical analysis, we used Fisher exact test and Spearman correlation in Stata software.After examining a total of 6157 FPMs, we found that 56.8% of our sample of adolescents had no caries in their 4 FPMs whereas 4.9% experienced caries in all 4. No significant differences emerged by sex (P > .05); however, by age, the older adolescents experienced greater FPM-DMFT (P < .05). Analysis yielded a correlation of r = 0.8693 between the FPM-DMFT and comprehensive DMFT scores (P < .0001) of participants. The underestimation of caries prevalence (DMFT > 0) was 5.4% (48.6% vs 43.2%), while the DMFT Index was underestimated at 0.34 (1.15 vs 0.81).The strong correlation between the FPM-DMFT and comprehensive DMFT Indices suggests that overall caries status can be inferred on the basis of FPM caries status. This evidence is useful when conducting large epidemiological studies such as national surveys.

Subgingival Microbiota of Mexicans with Type 2 Diabetes with Different Periodontal and Metabolic Conditions.

BACKGROUND: Type-2-Diabetes (T2D) and Periodontitis are major inflammatory diseases. However, not much is known about the specific subgingival microbiota in Mexicans with diabetes and metabolic dysbiosis. The aim of this study was to describe the subgingival microbiota of Mexicans with T2D and the different periodontal and metabolic conditions, through "Checkerboard" DNA-DNA hybridization. METHODS: Subjects were divided into two groups-periodontal-health (PH) (PH_non-T2D; n = 59, PH_T2D; n = 14) and generalized-periodontitis (GP) (GP_non-T2D; n = 67, GP_T2D; n = 38). Obesity (BMI ≥ 30 kg/m2) and serum levels of glycated-hemoglobin (HbA1c), total-lipids, triglycerides, total-cholesterol, high-density-lipids, and low-density-lipids were measured for the T2D individuals. Subgingival microbial identification was processed for 40 species through DNA-probes. RESULTS: Subjects with T2D harbored significantly higher mean total levels (PH: p < 0.001, and GP_NS), a lower proportion of "red" complex (GP: p < 0.01), a higher proportion of "yellow" (GP; p < 0.001), and "orange" (GP; p < 0.01) complex than the non-T2D. GP_T2D individuals exhibited a greater proportion of putative-species-Campylobacter gracilis and S. constellatus (p < 0.001), and Parvimonas micra and Prevotella nigrescens (p < 0.01), than GP_non-T2D. T2D individuals with HbA1c > 8% had presented significantly higher mean pocket-depth and higher levels of G. morbillorum (p < 0.05) and those with obesity or dyslipidemia harbored higher levels, prevalence, or proportion of Streptococcus sp., Actinomyces sp., and Capnocytophaga sp. CONCLUSIONS: T2D individuals harbored a particular microbial profile different to non-T2D microbiota. Metabolic control was related to dysbiosis of microbiota-HbA1c>8% related to periodontitis and obesity or dyslipidemia with the predominance of saccharolytic bacteria, irrespective of their periodontal condition.

Study protocol of the cost-effectiveness comparison of two preventive methods in the incidence of caries: A randomized, controlled clinical trial.

INTRODUCTION: Dental caries is the most frequent oral disease worldwide and the main cause of tooth loss in children and young adults. One of the most frequently affected areas is the occlusal surfaces of the first permanent molars (FPM) due to their morphological complexity. At present, several preventive treatments can reduce the incidence of this disease in school populations. In Mexico, the most commonly used technologies are those derived from some presentation of fluoride; on the other hand, research on this topic has been limited. OBJECTIVE: To determine the cost-effectiveness of two different methods for preventing the incidence of caries on the FPM of schoolchildren (6-8 years of age) from public primary schools. MATERIAL AND METHODS: This is a randomized experimental design. Participants will be assigned to two treatment groups of 114 each. In the first group, pit and fissure sealants will be applied, whereas the second group will receive a fluoride varnish. The work will be carried out in schoolchildren that attend public elementary schools in the state of Hidalgo, Mexico. The result variable will be the incidence of caries and the total cost of each of the interventions will be calculated in order to calculate the intervention's cost-effectiveness. CONCLUSION: This work will allow us to compare the cost-effectiveness of the pit and fissure sealants and the fluoride varnish in order to determine which offers the best results.

Out-Of-Pocket Expenditures on Dental Care for Schoolchildren Aged 6 to 12 Years: A Cross-Sectional Estimate in a Less-Developed Country Setting.

Aim: The objective of this study was to estimate the Out-Of-Pocket Expenditures (OOPEs) incurred by households on dental care, as well as to analyze the sociodemographic, economic, and oral health factors associated with such expenditures. Method: A cross-sectional study was conducted among 763 schoolchildren in Mexico. A questionnaire was distributed to parents to determine the variables related to OOPEs on dental care. The amounts were updated in 2017 in Mexican pesos and later converted to 2017 international dollars (purchasing power parities-PPP US $). Multivariate models were created: a linear regression model (which modeled the amount of OOPEs), and a logistic regression model (which modeled the likelihood of incurring OOPEs). Results: The OOPEs on dental care for the 763 schoolchildren were PPP US $53,578, averaging a PPP of US $70.2 ± 123.7 per child. Disbursements for treatment were the principal item within the OOPEs. The factors associated with OOPEs were the child's age, number of dental visits, previous dental pain, main reason for dental visit, educational level of mother, type of health insurance, household car ownership, and socioeconomic position. Conclusions: The average cost of dental care was PPP US $70.2 ± 123.7. Our study shows that households with higher school-aged children exhibiting the highest report of dental morbidity-as well as those without insurance-face the highest OOPEs. An array of variables were associated with higher expenditures. In general, higher-income households spent more on dental care. However, the present study did not estimate unmet needs across the socioeconomic gradient, and thus, future research is needed to fully ascertain disease burden.

Interproximal caries and premature tooth loss in primary dentition as risk factors for loss of space in the posterior sector: A cross-sectional study.

Dental caries-a highly prevalent public health problem in preschoolers and school children-is the main cause of premature dental loss during childhood, and this may be related to loss of space in the posterior sector. The objective of this study was to evaluate whether interproximal caries and premature tooth loss (D and/or E) are risk factors for loss of space in the posterior sector.A comparative cross-sectional study (split-mouth type) was performed in schoolchildren (6-8 years old). Seventeen gypsum models were evaluated. These children presented with unilateral loss of a dental organ or interproximal caries (teeth D and/or E) and without such affectations on the other side. Measurements were made with a digital Vernier caliper. The dependent variable was the difference (loss of space, mm) between the control and case sides. The independent variables were type of affectation (interproximal caries or tooth loss), sex, age, arcade, and number of interproximal surfaces affected.The mean age was 6.82 ±â€Š0.44 years and 64.7% were boys. The average space loss was 1.09 ±â€Š0.18 mm (control vs case; P < .0001). A greater loss of space was observed among those who lost a dental organ than those with interproximal caries (P = .0119). A correlation was observed between the variable loss of space and the number of interproximal surfaces affected (r = 0.5712, P = .0166).Interproximal caries and tooth loss were risk factors for loss of space in the posterior segment in this sample of Mexican schoolchildren.

Leche humana y su efecto sobre la mineralización del esmalte: revisión de literatura

La leche materna es el alimento que provee al niño desde su nacimiento de todos los nutrientes que necesita para su crecimiento y desarrollo físico y psicológico. Su efecto sobre el tejido dental ha sido objeto de controversias, ya que se ha visto que actúa sobre la mineralización del esmalte y se ha asociado a caries de la infancia temprana. La leche humana tiene diversos componentes protectores para el esmalte dental pero al mismo tiempo contiene factores que pueden generar la pérdida de minerales. El propósito de esta revisión es exponer los elementos que producen la desmineralización y la remineralización del esmalte y proponer algunas medidas que apoyen la integridad de este tejido, así como recomendar la lactancia materna como la alimentación principal que el infante debe recibir durante el primer año de vida. La leche humana tiene diversas proteínas y elementos que ayudan en el proceso de desmineralización y remineralización del esmalte dental de la primera dentición. Se puede concluir que, la leche materna es el alimento ideal para los niños en los primeros años de vida. Por lo que hay que promover la lactancia materna como el método preferido para alimentar a los bebés. Se debe implementar la higiene desde que el primer diente erupciona en boca. Esta medida evitará que el posible efecto desmineralizante de la leche ejerza un efecto irreversible sobre el esmalte dental. Es conveniente orientar a las madres sobre el almacenamiento de la leche materna de tal manera que al ser consumida por el niño, no se encuentre acidificada, y no produzca un efecto dañino sobre el esmalte.

Breast milk provides the child of all the nutrients he needs for his growth and physical and psychological development beginning at birth. Its effect on dental tissue has been the subject of controversy, since it has been seen to act on the mineralization of enamel and has been associated with early childhood caries. Human milk has various protective components for tooth enamel but at the same time it contains factors that can cause the loss of minerals. The purpose of this review is to review the elements that produce the demineralization and remineralization of enamel and propose some measures that support the integrity of this tissue, as well as to recommend breastfeeding as the main feeding source that the infant should receive during the first year of life. Human milk has various proteins and elements that help in the process of demineralization and remineralization of the tooth enamel of first dentition. It can be concluded that, breast milk is the ideal food for children during the first years of life. Therefore, breastfeeding should be promoted as the preferred method of feeding babies. Oral hygiene should be implemented as soon as the first tooth erupts. This measure will prevent the possible demineralizing effect of milk from exerting an irreversible effect on tooth enamel. It is advisable to guide mothers on the storage of breast milk so that when consumed by the child, it is not acidified, and does not produce harmful effects on the enamel.

Socioeconomic Inequalities in Visits to the Dentist to Receive Professionally Applied Topical Fluoride in a Developing Country.

OBJECTIVE: To determine the frequency and associated factors of visits to the dentist in the last year by Nicaraguan schoolchildren to receive professionally applied topical fluoride (PATF). MATERIAL AND METHODS: A cross-sectional study was designed in children from public schools in the city of León, Nicaragua, were included. A series of socioeconomic, sociodemographic, and behavioural variables were collected through a questionnaire. The dependent variable was the visit to the dentist to receive professionally applied topical fluoride in the last year, which was dichotomised as (0) Did not receive PATF and (1) Yes received PATF. In the statistical analysis, binary logistic regression was used. RESULTS: The mean age of the students included was 9 years, and 49.9% were girls. The prevalence of visits to the dentist in the last year to receive PATF was 3.1%. In the multivariate model, the associated characteristics (p < 0.05) were: female (OR = 2.73, 95% CI = 1.34-4.50); the positive attitude of the mother to the oral health of her child (OR = 2.15, 95% CI = 1.03-4.50); and the best socioeconomic position (OR = 2.68, 95% CI = 1.36-5.31). CONCLUSIONS: The prevalence of visits to the dentist in the last year to receive professionally applied topical fluoride was very low (3.1%). The results of the socioeconomic position suggest the existence of certain inequalities in oral health. It is necessary to implement policies and programs aimed at improving this scenario.

Dientes natales y neonatales: una revisión de la literatura

Los dientes que erupcionan antes de tiempo, desde el nacimiento o posterior a éste, son denominados comúnmente dientes natales o neonatales. Se clasifican de acuerdo al grado de maduración o apariencia. La prevalencia varía de 1 en 44 a 1 en 30,000 nacimientos. Son más frecuentes los dientes natales que los neonatales. Por lo general, pertenecen a la dentición primaria, ocurren de forma bilateral y predominan entre las mujeres. Todavía de etiología desconocida, la teoría más aceptable es que el germen dental tiene una localización superficial. Clínicamente se ven como dientes primarios normales, suelen ser más pequeños, algunas veces de forma cónica. Generalmente son móviles por la falta de formación radicular y presentan alteraciones del esmalte; pueden revelar una apariencia inmadura con hipoplasia del esmalte de bordes irregulares y agudos; su coloración puede ser marrón-amarillento / opaco blanquecino. Radiográficamente hay ausencia de raíz. Histológicamente, la mayoría de los dientes natales y neonatales pueden seguir un patrón de mineralización normal, pero también presentan alteraciones tanto en el esmalte como en la dentina. Otros descubrimientos incluyen ausencia de la capa basal de Weil, vaina de Hertwig y cemento; además de un incremento en el número de vasos sanguíneos dilatados en la pulpa. El tratamiento debe ser adaptado a cada diente y cada niño. Los tratamientos disponibles son: la extracción o el mantenimiento del diente en la arcada. La complicación más común de los dientes neonatales o natales es la ulceración traumática de la parte ventral de la lengua debido a la fricción, llamada úlcera de Riga Fede. No hay reporte de broncoaspiración. El tratamiento de los dientes natales y neonatales deben valorarse con mucho cuidado; estimando su movilidad, integridad, compromiso de la alimentación y la presencia de alguna úlcera.

Teeth that erupt early are commonly referred to as natal or neonatal teeth. They can be classified according to the degree of maturity or appearance. Their prevalence varies from 1 in 44 to 1 in 30,000 births. Natal teeth are more frequent than neonatal teeth, and they often belong to the primary dentition; they occur bilaterally and principally among women. The etiology of these teeth is unknown, and the most acceptable theory is that the tooth germ is located superficially. Clinically, they resemble normal primary teeth, although they are often smaller and sometimes conical. They are generally characterized by a lack of root formation, changes in enamel and dentin, an immature appearance with hypoplastic enamel and sharp irregular and edges, and yellowish-brown/white opaque coloration. Radiographically there is no root. Histologically, most natal and neonatal teeth may follow a pattern of normal mineralization, but also have alterations in both enamel and dentin. Other findings include absence of the basal layer of Weil, Hertwig's sheath and cement; besides an increase in the number of blood vessels in dilated pulp. Treatment should be tailored to each tooth and each child. Available treatments include extraction or maintenance of the tooth in the arch. The most common complication of neonatal teeth or natal is traumatic ulceration of the ventral portion of the tongue due to friction, called Fede-Riga disease (ulcer). No reports of aspiration exist in the literature. The treatment of natal and neonatal teeth should be assessed very carefully to estimate their mobility, integrity, feeding baby, and the presence of some ulcers.

Tooth demineralization and associated factors in patients on fixed orthodontic treatment.

Dental demineralization was determined in patients at three time points during fixed orthodontic treatment. A multiple cross-sectional study included 108 patients divided into three different groups: (1) beginning of orthodontic treatment; (2) one year into treatment; and (3) two years into treatment. Demineralization was estimated using a DIAGNOdent pen. We obtained data from multiple tooth-by-tooth demineralization readings combined with salivary pH and patients' oral hygienic and dietary behaviors. A t-test for independent samples and Spearman´s correlation were performed. No demineralizations differences were found between the initial stage and one year into treatment. Between one and two years small differences were observed, but demineralization increased between the initial stage and second treatment year, predominating in upper right central incisors (p = 0.056), upper left lateral incisors (p = 0.040), both upper canines (p = 0.055 and p = 0.040, respectively) and first left premolars (p = 0.034 and p = 0.053, respectively). We did not find associations between oral hygiene and dietary behaviours or salivary pH. In conclusion, demineralization occurred in first year of treatment and increased during second year, predominating in the upper arch and the left side mainly in upper right central incisors, upper left lateral incisors, both upper canines, and first left premolars.

Edentulism and other variables associated with self-reported health status in Mexican adults.

BACKGROUND: To determine if edentulism, controlling for other known factors, is associated with subjective self-report health status (SRH) in Mexican adults. MATERIAL AND METHODS: We examined the SRH of 13 966 individuals 35 years and older, using data from the National Survey of Performance Assessment, a cross-sectional study that is part of the technical collaboration between the Ministry of Health of Mexico and the World Health Organization, which used the survey instrument and sampling strategies developed by WHO for the World Health Survey. Sociodemographic, socioeconomic, medical, and behavioral variables were collected using questionnaires. Self-reported health was our dependent variable. Data on edentulism were available from 20 of the 32 Mexican states. A polynomial logistic regression model adjusted for complex sampling was generated. RESULTS: In the SRH, 58.2% reported their health status as very good/good, 33.8% said they had a moderate health status, and 8.0% reported that their health was bad/very bad. The association between edentulism and SRH was modified by age and was significant only for bad/very bad SRH. Higher odds of reporting moderate health or poor/very poor health were found in women, people with lower socio-economic status and with physical disabilities, those who were not physically active, or those who were underweight or obese, those who had any chronic disease, and those who used alcohol. CONCLUSIONS: The association of edentulism with a self-report of a poor health status (poor/very poor) was higher in young people than in adults. The results suggest socioeconomic inequalities in SRH. Inequality was further confirmed among people who had a general health condition or a disability. Dentists and health care professionals need to recognize the effect of edentulism on quality of life among elders people.